Poor asthma prescribing compromising health of children

An alarming number of children under five years of age are being prescribed asthma medication outside of national guidelines, leading to calls for better education of health care providers.

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An alarming number of children under five years of age are being prescribed asthma medication outside of national guidelines, new research shows.

The study, by medical researchers at UNSW and Sydney Children’s Hospital, was presented in Adelaide today to health professionals at the Australia and New Zealand Annual Scientific Meeting for Leaders in Lung Health & Respiratory Science (TZANZRS), hosted by the Thoracic Society of Australia and New Zealand.

The Australian Asthma Handbookby the National Asthma Council Australia suggests a stepwise approach to the management of asthma, with stepping up or down of asthma medications depending on the control of asthma symptoms.

The guidelines advise that inhaled fixed dose combination medications – a combination of inhaled steroids and a long acting beta agonist - are not recommended in children aged under 5.

If the initial use of low-dose inhaled corticosteroid alone fails to control the symptoms, other treatment options are preferable.

The study, led by Dr Nusrat Homaira of the UNSW School of Women's and Children's Health, found that an estimated 800,000 children are prescribed an asthma medication each year across the country.

The prescription of fixed dose combination inhalers is common in children under 5 years of age, despite this being outside of the age recommended in national guidelines.

There is also high prescribing of these inhalers without prior prescribing of inhaled corticosteroids - also not compliant with guidelines.

Professor Allan Glanville, President of the Thoracic Society of Australia and New Zealand, said the study had identified an area of great concern.

“Correct asthma management in children – particularly in those under 5 years – is absolutely critical to prevent exacerbations, increase the chance of prolonged remission of asthma and build healthy lungs into adult life.

After years of being stable, asthma deaths are slowly increasing, and a multitude of studies have highlighted poor asthma control across the country.

“We have always known that adherence to medications in this group has been a challenge. Finding evidence that medications are being prescribed incorrectly from the outset highlights the importance of health care provider education as well as the need to increase public awareness,” he said.

Australia has one of the highest rates of asthma in the world, affecting approximately 2.5 million people. More than half of the approximately 40,000 asthma hospitalisations in Australia each year are in children aged 0-14, peaking in children aged 0-4 years. Excessive use of health care resources is a marker of poorly controlled asthma and is associated with inadequate or inappropriate use of asthma medication.

After years of being stable, asthma deaths are slowly increasing, and a multitude of studies have highlighted poor asthma control across the country. Earlier research found that only 25% of adults and 40% of children with asthma have a written asthma plan.

In addition, nearly 40% of people with asthma turn to “quick fixes” - medication such as Ventolin to manage their symptoms - instead of using preventive, anti-inflammatory medications to avoid flare ups in the first place.

“The Australian Asthma Handbook advises doctors treating children under five with asthma to use the lowest level of medication required to minimise the side effects, so that they can live well with asthma, and to use a stepped approach to adjusting their asthma medication,” said Professor Amanda Barnard, General Practitioner and Chair of National Asthma Council Australia’s Guidelines Committee.

“Doctors should check whether the symptoms are due to asthma, incorrect inhaler technique, or poor adherence before considering stepping up medication.”

Michele Goldman, CEO of Asthma Australia, said: “Creating and sticking to asthma treatment plans in accordance to national asthma guidelines is the best way to protect the health of children and adults with asthma.

“GPs need to be aware of the guidelines and ensure they are prescribing medication in line with them. Open communication between GPs, parents and people with asthma is also very important, so that concerns can be discussed.

“Education is vital for a person with asthma to understand why they need their medication, how it works and the correct way to use their delivery device, such as a puffer with a spacer.

“This will help improve adherence and ensure that patients are getting the most benefit from their medication. This approach is most likely to limit asthma symptoms and flare-ups, and reduce the likelihood of higher doses or stronger medication being prescribed unnecessarily,” she said.